Session 0

We call the first session of cognitive behaviour therapy (CBT) for binge-eating disorder (BED) Session 0 because it represents the baseline, or starting point. It includes five components, the first of which is engaging the patient in treatment and the process of change. To this end, the therapist needs to pay careful attention to their attitude toward the patient and the words used to address the topics of binge eating and clinical obesity, and avoid any verbal or non-verbal expressions of weight stigma. The second component is assessing the current state of the patient’s eating disorder, with reference to the previous 4 weeks. The third component is collaboratively creating the personal formulation, a visual representation (a flow chart) of the processes that appear to be maintaining the patient’s binge-eating episodes and, if present, clinical obesity. The fourth component is informing the patient about the nature of the treatment. The fifth and last component is introducing real-time self-monitoring, a key procedure of CBT for BED that consists of self-reporting, on a dedicated monitoring record, the relevant behaviours, thoughts, emotions, and events “in the moment” in which they are experienced. Finally, the session is concluded by summarizing its content, re-stating the homework assignment(s), and scheduling the next appointment.